scholarly journals Effects of Thoracic Paravertebral Block on Nociceptive Levels After Skin Incision During Video-Assisted Thoracoscopic Surgery

2019 ◽  
Vol 25 ◽  
pp. 3140-3145 ◽  
Author(s):  
Hiroki Miyawaki ◽  
Hiroki Ogata ◽  
Shiroh Nakamoto ◽  
Takahiko Kaneko ◽  
Ryusuke Ueki ◽  
...  
Keyword(s):  
Thoracoscopic Surgery ◽  
Skin Incision ◽  
Paravertebral Block ◽  
Thoracic Paravertebral Block ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

scholarly journals Thoracic Paravertebral Block with Adjuvant Dexmedetomidine in Video-Assisted Thoracoscopic Surgery: A Randomized, Double-Blind Study

2019 ◽  
Vol 8 (3) ◽  
pp. 352 ◽  
Author(s):  
Boohwi Hong ◽  
ChaeSeong Lim ◽  
Hyemin Kang ◽  
Hongsik Eom ◽  
Yeojung Kim ◽  
...  
Keyword(s):  
Rating Scale ◽  
Thoracoscopic Surgery ◽  
Wedge Resection ◽  
Paravertebral Block ◽  
P Value ◽  
Double Blind Study ◽  
Thoracic Paravertebral Block ◽  
Video Assisted ◽  
Fentanyl Consumption ◽  
Video Assisted Thoracoscopic Surgery

Background: The addition of the adjuvant dexmedetomidine to a nerve block improves the quality of the block and reduces perioperative opioid consumption. The aim of this study was to assess the effect of dexmedetomidine as an adjuvant for the thoracic paravertebral block (TPVB) in postoperative pain control after video-assisted thoracoscopic surgery (VATS). Methods: Sixty-six males, aged 15–40 years, with spontaneous pneumothorax scheduled for VATS wedge resection were enrolled. Following surgery, ultrasound-guided TPVB was performed on the T3 and T5 levels with 30 mL of 0.5% ropivacaine, plus adjuvant dexmedetomidine 50 μg or normal saline. The primary outcome was cumulative fentanyl consumption at 24 h. Pain severity, the requirement for additional rescue analgesics, hemodynamic variations, and side effects were also evaluated. Results: Median postoperative cumulative fentanyl consumption at 24 h was significantly lower in the dexmedetomidine group (122.6 (interquartile range (IQR) 94.5–268.0) μg vs. 348.1 (IQR, 192.8–459.2) μg, p-value = 0.001) with a Hodges–Lehman median difference between groups of 86.2 (95% confidence interval (CI), 4.2–156.4) mg. Coughing numeric rating scale (NRS) was lower in the dexmedetomidine group at postoperative 2, 4, 8, and 24 h. However, resting NRS differed significantly only after 4 h postoperative. Conclusions: Dexmedetomidine as an adjunct in TPVB provided effective pain relief and significantly reduced opioid requirement in VATS.

scholarly journals Out of plane approach to erector spinae plane block

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
Poonam Darswal ◽  
Divesh Arora
Keyword(s):  
Clinical Practice ◽  
Thoracoscopic Surgery ◽  
Erector Spinae ◽  
Effective Alternative ◽  
Thoracic Paravertebral Block ◽  
Video Assisted ◽  
Erector Spinae Plane Block ◽  
Out Of Plane ◽  
Analgesic Technique ◽  
Video Assisted Thoracoscopic Surgery

We were interested in applying the appealingly safer yet equally effective alternative suggested to thoracic paravertebral block – the erector spinae plane (ESP) block by Forereo1 to our clinical practice. ESP block is being used as an effective analgesic technique in abdominal and thoracic procedures like video-assisted thoracoscopic surgery (VATS) and bariatric surgeries.2,3 It is a very safe and effective analgesic technique with minimal potential for major complications. ESP block proved to be effective for analgesia in breast surgeries as well. 

scholarly journals The nociception level index (NOL) response to intubation and incision in patients undergoing video-assisted thoracoscopic surgery (VATS) with and without thoracic epidural analgesia. A pilot study.

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 875 ◽  
Author(s):  
Laurent A. Bollag ◽  
Srdjan Jelacic ◽  
Carlos Delgado Upegui ◽  
Cynthia Wu ◽  
Philippe Richebe
Keyword(s):  
Pilot Study ◽  
Epidural Analgesia ◽  
Thoracoscopic Surgery ◽  
Area Under The Curve ◽  
Skin Incision ◽  
Thoracic Epidural Analgesia ◽  
Clinical Trial Registry ◽  
Thoracic Epidural ◽  
Video Assisted ◽  
Video Assisted Thoracoscopic Surgery

Background: The PMD100™ (Medasense Biometrics Ltd., Ramat Yishai, Israel) is a novel non-invasive nociception monitor that integrates physiological parameters to compute a real-time nociception level index (NOL) in the anesthetized patients. Thoracic epidural analgesia provides effective analgesia and improves surgical outcomes. Side effects include sympathectomy, hypotension, changes in skin temperature and a decreased cardiac accelerator fiber tone. The purpose of this pilot study was to evaluate changes in NOL values after incision in patients with and without epidural analgesia.   Methods: Half of the patients scheduled for Video-Assisted Thoracoscopic Surgery (VATS) received a thoracic epidural catheter, placed and tested 2h before surgery and activated prior to incision. The other half of the patients received i.v. fentanyl (1 mcg/kg) five minutes before incision. Anesthesia and analgesia were maintained in a standardized manner. NOL and heart rate (HR) were compared before and after the nociceptive stimuli intubation and skin incision. Results: NOL significantly increased in all patients after intubation by 10.2 points (CI: 4.5-16.0; p=0.002) as well as HR by 9 beats per minute after intubation in all patients (CI: 3.3-15.6; p=0.01). After incision, in patients without epidural analgesia the NOL increased by 13.9 points (CI: 7.4-20.3; p=0.0001), compared to 5.4 points (CI: -6.3-17.1; p=0.29) in patients with epidural analgesia. HR did not significantly vary after incision in both groups. The area under the curve of delta NOL and delta HR variations after incision were significantly different (p<0.05) between groups and delta NOL variations were significantly different from baseline values but not the delta HR variations. Conclusions: This pilot study suggests that the PMD100™ Monitor may be a useful tool to evaluate the efficacy of an intraoperative thoracic epidural analgesia. Clinical Trial Registry Number: ClinicalTrials.gov record ID: NCT01978379 registered 10/25/2014.

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